Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
Division of Epidemiological Methodology and Radiation Research, Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
PLoS One. 2018 Mar 27;13(3):e0194846. doi: 10.1371/journal.pone.0194846. eCollection 2018.
Children with chronic health conditions may perform poorer at school. Associations may be confounded by numerous social factors. We aimed to estimate the effects of a chronic health condition on overall school performance in first graders with an emphasis on rigorous adjustment for potential confounders.
A population-based cohort study was performed in the area of Mainz-Bingen (Germany). In 2015 all preschoolers were approached and the presence of a chronic health condition was assessed by parental questionnaires and preschool health examination data. The identification of a chronic health condition was based on special health care needs and presence of a doctor's diagnosis out of 24 school-relevant diseases. At the end of the first school year, overall school performance was assessed by teachers and rated on a 5-item scale ranging from -10 to +10.
Of 3683 children approached, 2003 were enrolled. Overall school performance was available for 1462 children (51% boys). Of these, 52% suffered from a chronic health condition. Compared to children without a chronic health condition, children with special health care needs (15%) performed worse at school (adjusted mean difference: -0.95, 95% CI: [-1.55; -0.35], P = 0.002). Children with a doctor's diagnosis but without special health care needs (37%) did not perform worse at school. The effect was further analysed considering the extent of special health care needed.
Chronic health conditions affect overall school performance early in primary school. To identify academically at-risk children, a chronic health condition identification based on special health care needs may be used.
患有慢性健康状况的儿童在学校的表现可能较差。许多社会因素可能会混淆这些关联。我们旨在评估慢性健康状况对一年级学生整体学业成绩的影响，并特别强调对潜在混杂因素进行严格调整。
在美因茨-宾根地区（德国）进行了一项基于人群的队列研究。2015 年，所有学龄前儿童都被接触到，通过家长问卷和学龄前健康检查数据评估慢性健康状况的存在。慢性健康状况的识别是基于特殊的医疗需求和医生诊断出的 24 种与学校相关的疾病之一。在第一学年结束时，由教师评估整体学业成绩，并在-10 到+10 的 5 项量表上进行评分。
在接触的 3683 名儿童中，有 2003 名儿童入组。共有 1462 名儿童（51%为男孩）获得了整体学业成绩。其中，52%的儿童患有慢性健康状况。与没有慢性健康状况的儿童相比，有特殊医疗需求的儿童（15%）在学校的表现较差（调整后的平均差异：-0.95，95%置信区间：[-1.55；-0.35]，P = 0.002）。有医生诊断但没有特殊医疗需求的儿童（37%）在学校的表现并不差。进一步分析了考虑特殊医疗需求程度的效果。
慢性健康状况会影响小学早期的整体学业成绩。为了识别学业上处于危险中的儿童，可以使用基于特殊医疗需求的慢性健康状况识别方法。
